Case Reports
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Journal of Structural Heart Disease, December 2017, Volume 3, Issue 6:192-198
DOI: 10.12945/j.jshd.2017.033.17
Worsening of Functional Mitral Regurgitation from Septal Dyssynchrony Induced by Ventricular Pacing in Ebstein's Anomaly Undergoing Percutaneous Mitral Valve Repair
Heajung L. Nguyen, MD1, Marcella A. Calfon Press, MD, PhD2, Jamil A. Aboulhosn, MD3, Jeannette P. Lin, MD3, Peyman Benharash, MD4, Eric H. Yang, MD2
1 Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA
2 Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA
3 Department of Medicine, Ahmanson-UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA
4 Division of Cardiothoracic Surgery, Department of Surgery, University of California at Los Angeles, Los Angeles, California, USA
Abstract
A 67-year-old male with Ebstein’s anomaly and a dual-chamber pacemaker due to sick sinus syndrome was admitted to our hospital with cardiogenic shock. Echocardiography revealed severe functional mitral valve regurgitation with preserved ejection fraction. He was referred for percutaneous mitral valve repair (PMVR) for refractory shock in the setting of prohibitive surgical risk. Invasive hemodynamics obtained during PMVR revealed worsening mitral regurgitation due to septal dyssynchrony induced by the patient’s permanent pacing. He underwent successful PMVR with subsequent clinical recovery. Dyssynchrony from right ventricular apical pacing may exacerbate mitral regurgitation and heart failure. PMVR with MitraClip may be a safe and effective therapeutic option in patients with refractory cariogenic shock and severe mitral regurgitation.
Cite this article as: Nguyen HL, Calfon Press MA, Aboulhosn JA, Lin JP, Benharash P, Yang EH. Worsening of Functional Mitral Regurgitation from Septal Dyssynchrony Induced by Ventricular Pacing in Ebstein's Anomaly Undergoing Percutaneous Mitral Valve Repair. Structural Heart Disease 2017;3(6):192-198. DOI: 10.12945/j.jshd.2017.033.17
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Case Reports
Journal of Structural Heart Disease, December 2017, Volume 3, Issue 6:192-198
DOI: 10.12945/j.jshd.2017.033.17
Worsening of Functional Mitral Regurgitation from Septal Dyssynchrony Induced by Ventricular Pacing in Ebstein's Anomaly Undergoing Percutaneous Mitral Valve Repair
Heajung L. Nguyen, MD1, Marcella A. Calfon Press, MD, PhD2, Jamil A. Aboulhosn, MD3, Jeannette P. Lin, MD3, Peyman Benharash, MD4, Eric H. Yang, MD2
1 Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA
2 Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA
3 Department of Medicine, Ahmanson-UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA
4 Division of Cardiothoracic Surgery, Department of Surgery, University of California at Los Angeles, Los Angeles, California, USA
Abstract
A 67-year-old male with Ebstein’s anomaly and a dual-chamber pacemaker due to sick sinus syndrome was admitted to our hospital with cardiogenic shock. Echocardiography revealed severe functional mitral valve regurgitation with preserved ejection fraction. He was referred for percutaneous mitral valve repair (PMVR) for refractory shock in the setting of prohibitive surgical risk. Invasive hemodynamics obtained during PMVR revealed worsening mitral regurgitation due to septal dyssynchrony induced by the patient’s permanent pacing. He underwent successful PMVR with subsequent clinical recovery. Dyssynchrony from right ventricular apical pacing may exacerbate mitral regurgitation and heart failure. PMVR with MitraClip may be a safe and effective therapeutic option in patients with refractory cariogenic shock and severe mitral regurgitation.
Supplemental Media
Video 1: Two-dimensional transesophageal echocardiography of the mitral valve as seen in Figure 2A before percutaneous mitral valve repair.
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Video 2: Three-dimensional transesophageal echocardiography of the mitral valve as seen in Figure 2B before percutaneous mitral valve repair.
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Video 3: Two-dimensional transesophageal echocardiography of the mitral valve as seen in Figure 2C after percutaneous mitral valve repair.
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Video 4: Three-dimensional transesophageal echocardiography of the mitral valve as seen in Figure 2D after percutaneous mitral valve repair.
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Cite this article as: Nguyen HL, Calfon Press MA, Aboulhosn JA, Lin JP, Benharash P, Yang EH. Worsening of Functional Mitral Regurgitation from Septal Dyssynchrony Induced by Ventricular Pacing in Ebstein's Anomaly Undergoing Percutaneous Mitral Valve Repair. Structural Heart Disease 2017;3(6):192-198. DOI: 10.12945/j.jshd.2017.033.17
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